Cost Analysis, Complications, and Discharge Disposition Associated With Simultaneous vs Staged Bilateral Total Knee Arthroplasty

Sobh, Ali; Siljander, Matthew P.; Mells, Anthony J.; Koueiter, Denise M.; Moore, Drew D.; Karadsheh, Mark S.

doi:10.1016/j.arth.2017.09.004

Cited by 50 publications

(57 citation statements)

References 25 publications

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“…Despite bilateral knee and hip arthroplasty being frequently performed, most studies paid attention to clinic outcomes, and only a few studies have been published recently on this topic. However, previous studies have not compared costs about THA, to say nothing of comparing costs when pooled both THA and TKA patients [2,7,12]. In this study, we compared the cost of simultaneous and staged procedures among TKA, THA, and their combination groups, found a signi cant difference between the two procedures in three groups.…”

Section: Discussionmentioning

confidence: 86%

“…A study from Taiwan demonstrated that all categories of medical costs, except for therapeutic procedure fees, were lower in the simultaneous TKA group [2]. However, a recent single-center study concluded that there was no signi cant difference in total hospital costs between two groups of TKA, and it might be explained that the majority of their patients who received simultaneous TKA underwent patient rehabilitation(IPR) unit admission, and IPR costs were added for all patients discharged to IPR [7].…”

Section: Discussionmentioning

confidence: 99%

“…When it turns to TKA, several studies reported a lower rate of complications in the simultaneous TKA group [14,16,19,24,25]. Whereas some studies have reported a higher rate of speci c complications, such as venous thromboembolism (VTE) [7] and myocardial infarction (MI) [26] for the patients older than 65 years in the simultaneous TKA group. However, Sheth et al [27] considered that the differences in the baseline characteristics of the patients, surgeon's preference, and hospital characteristics may hamper the prior comparisons of complications between simultaneous TKA and staged TKA.…”

Section: Discussionmentioning

confidence: 99%

“…These are two different strategy of surgical procedures. However, there exists debate regarding performing staged bilateral TKA or THA with an interval between procedures or simultaneous bilateral TKA or THA patients, primarily because of the controversy about the outcomes of two procedures [7,12]. The comparison between the two types of surgery is not consistent.…”

Section: Introductionmentioning

confidence: 99%

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Costs analysis of Staged Versus Simultaneous Bilateral Total Knee and Hip Arthroplasty: a university affiliated hospital survey of 1579 Chinese patients

Hou

Zhang³

et al. 2020

Preprint

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Background Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are required for many patients. No recent studies that concentrate on the costs for each of the payment items both for TKA and THA when comparing simultaneous bilateral procedures with staged arthroplasty. This study aimed to evaluate the medical costs, length of stay(LOS), blood transfusion, and in-hospital complications in patients undergoing simultaneous TKA or THA and staged TKA or THA. Methods A retrospective cohort study was conducted by analyzing 1,579 patients from a single institution. All patients who underwent primary bilateral TKA or THA from 2013 to 2018 were divided into three groups: TKA,THA and all patients. Then, we grouping simultaneous bilateral groups and staged bilateral groups in these three groups respectively. Finally, these two sub-groups(simultaneous bilateral groups and staged bilateral groups) were compared between the three groups(TKA, THA, and pooled groups). Results All categories of medical costs, except for materials fees which were higher in the simultaneous bilateral THA and pooled groups but with no statistical significance, were lower in the simultaneous TKA, THA and pooled simultaneous groups. The total average medical costs in simultaneous and staged bilateral TKA groups were $15,535.621and $16,747.192, p <0.001), respectively; THA groups were $15,046.210 and $16,126.808, ( p =0.003), respectively; pooled groups were $16,506.971and $15,467.561, ( p <0.001), respectively. All costs were presented in the United States dollar. The highest and lowest costs were materials fees and nursing care fees. No significant differences were found for five common co-morbidities and postoperative complications between the two sub-groups in three groups. The simultaneous groups had a shorter LOS, a higher incidence of blood transfusion than staged groups whether it is TKA groups or THA or pooled groups. Conclusions These results indicate that simultaneous bilateral TKA and THA with a shorter LOS is more economical than staged bilateral TKA and THA. Counts of complications were not affected by the choice for staged or simultaneous bilateral total arthroplasty. But blood transfusion was more prevalent in the simultaneous groups both for TKA and THA.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Costs analysis of Staged Versus Simultaneous Bilateral Total Knee and Hip Arthroplasty: a university affiliated hospital survey of 1579 Chinese patients

Hou

Zhang³

et al. 2020

Preprint

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“…Sim‐BTKA's cost advantage is likely to diminish overtime with the trend towards shorter acute LOS following TKA . However, outpatient costs should remain lower following sim‐BTKA, as only one sequence of appointments and investigations are required compared to two sequences for staged BTKA.…”

Section: Discussionmentioning

confidence: 99%

Simultaneous (two‐surgeon) versus staged bilateral knee arthroplasty: an observational study of intraoperative and post‐operative outcomes

Gill

Hill‐Buxton

Gwini

et al. 2020

ANZ Journal of Surgery

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Background: The advantages of simultaneous bilateral total knee arthroplasty (sim-BTKA) remain controversial. This study investigated the effects of two-surgeon sim-BTKA compared to separate admission staged BTKA regarding intraoperative and post-operative outcomes and health service costs. Methods: Patients underwent sim-BTKA or staged BTKA between 1 November 2008 and 30 June 2016. Data were extracted from a joint replacement registry and medical records. Median regression and chi-squared tests were used for between-group comparisons. Results: Median hospital total length of stay was 5 days less for sim-BTKA (n = 122) than staged BTKA group (n = 46) (7 versus 12; 95% confidence interval (CI) 3.9, 6.1), and 9 days less for inpatient rehabilitation (17 versus 26; 95% CI 3.7, 14.3). However, 80% of sim-BTKA patients went to inpatient rehabilitation (versus 27% following staged BTKA), so median total length of stay was 9 days less for staged BTKA (13 versus 22; 95% CI −12.8, −5.2). Total anaesthesia time was 135 min less for sim-BTKA (P < 0.001), while staged BTKA required less blood transfusions (P = 0.001). Complication rates were similar, except for superficial infections which were observed twice as often after staged BTKA (30% versus 15%, P = 0.048). Twelve months following sim-BTKA and the first staged total knee arthroplasty, sim-BTKA had better WOMAC pain, stiffness and function scores (P ≤ 0.05). Average inpatient costs (hospital and rehabilitation) were $6388 less for sim-BTKA. Conclusion: Sim-BTKA appears to be a comparatively safe alternative to staged BTKA. Sim-BTKA may be superior to staged BTKA due to faster improvements in pain and function and lower healthcare costs. How these results generalize to other health services requires further investigation.© 2020 Royal Australasian College of Surgeons ANZ J Surg 90 (2020) 826-832ANZJSurg.com

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Risks and Benefits of Bilateral Total Knee Replacement Surgery

Huerfano¹,

Shanaghan²,

Vulcano³

et al. 2020

Perioperative Care of the Orthopedic Patient

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Cost Analysis, Complications, and Discharge Disposition Associated With Simultaneous vs Staged Bilateral Total Knee Arthroplasty

Cited by 50 publications

References 25 publications

Costs analysis of Staged Versus Simultaneous Bilateral Total Knee and Hip Arthroplasty: a university affiliated hospital survey of 1579 Chinese patients

Costs analysis of Staged Versus Simultaneous Bilateral Total Knee and Hip Arthroplasty: a university affiliated hospital survey of 1579 Chinese patients

Simultaneous (two‐surgeon) versus staged bilateral knee arthroplasty: an observational study of intraoperative and post‐operative outcomes

Risks and Benefits of Bilateral Total Knee Replacement Surgery

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